Early Childhood Caries (ECC) is of high public health importance because of its (a) associated pain, and elevated risk for infection, emergency department visits, hospitalization, and treatment under general anesthesia (with its attendant risks and expense);(b) increased risk for future caries in primary and permanent teeth;(c) impact on physical development (due to ECC negatively affecting eating and nutrition);and (d) impact on cognitive development (due to increase in school absences and pain-reduced capacity to learn). ECC has increased from 24% to 28% in 2-5 year-old children between 1988-1994 and 1999-2004, with the prevalence of Severe ECC (S-ECC) at 5%, or over 300,000 children (Dye et al., 2007). This increase is disheartening because of both the upward trajectory and an absolute rate more than double the Healthy People 2010 oral health objective of less than 12% for U.S. 2- 4 year olds. Despite its health impact, cost, and widespread incidence and prevalence, preventing ECC - especially among diverse ethnic, social, and economic populations - continues to elude clinicians. Although ECC is instigated by certain acidogenic and aciduric members of the biofilm (Streptococcus mutans) and is nearly entirely preventable, its intractable (and even rising) prevalence indicates the strong influences of what are known as social determinants of health (e.g., familial, cultural, social, economic, political, environmental factors) (e.g., Newton &Bower, 2005;Watt, 2007;Yevlahova &Satur, 2009). This project is the first to employ a time period when couples are maximally open to intervention in the service of oral, physical, and psychological health (i.e., after the birth of a child). It will be the first to intervene with new parents on three hypothesized social determinants of ECC simultaneously: (a) noxious family environments, (b) daily oral health behaviors/promotion for children, and (c) regular, recommended child dental check-ups. Dentistry has discussed building a "dental home" for consistent, ongoing, positive services. This project moves this home out of the dentist's office and into the family abode, where the daily behaviors and environments that either increase or mitigate the risk for ECC are. This paradigm shift, what we term the oral healthy home, could revolutionize outreach to families at high risk for ECC, both by having the home promote oral health on a daily basis and by increasing the use of the "dental home" at recommended intervals. PUBLIC HEALTH RELEVANCE: Early Childhood Caries (ECC) is of high public health importance because of its (a) associated pain, and elevated risk for infection, emergency department visits, hospitalization, and treatment under general anesthesia (with its attendant risks and expense);(b) increased risk for future caries in primary and permanent teeth;(c) impact on physical development (due to ECC negatively affecting eating and nutrition);and (d) impact on cognitive development (due to increase in school absences and pain-reduced capacity to learn). This project is the first to employ a time period when couples are maximally open to intervention in the service of oral, physical, and psychological health (i.e., after the birth of a child) and will plan and pilot interventions with new parents on three hypothesized social determinants of ECC simultaneously: (a) noxious family environments, (b) daily oral health behaviors/promotion for children, and (c) regular, recommended child dental check-ups.